Young Exceptional Children

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How Can I Help? Prompting Procedures to Support Children's Learning Hedda Meadan, Michaelene Ostrosky, Amy Santos and Melinda R. Snodgrass Young Exceptional Children published online 30 September 2013 DOI: 10.1177/1096250613505099 The online version of this article can be found at: http://yec.sagepub.com/content/early/2013/09/29/1096250613505099.citation

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How Can I Help? Prompting Procedures to Support Children’s Learning

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An adult who is skilled in providing assistance can influence how quickly and accurately a child learns a new skill or performs it independently.

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Hedda Meadan, PhD, BCBA-D Michaelene M. Ostrosky, PhD Rosa Milagros Santos, PhD Melinda R. Snodgrass, MS University of Illinois at Urbana– Champaign, USA

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amantha is a 2-year-old girl who lives with her mother, Shalene, and her maternal grandmother, Doris. Samantha has developmental delays and therefore receives early intervention services. Samantha loves to play with dolls, swing at the park, and eat bananas. She is even having a banana cake for her third birthday party in 2 months! Samantha is very social and enjoys the attention from others when they praise her or clap for her. One of the goals on Samantha’s Individual Family Service Plan (IFSP) is to independently complete simple puzzles. Shalene and Samantha’s therapists hope that working on simple puzzles will help Samantha develop better fine motor skills, but they are not sure of the best way to teach her how to complete big knob puzzles independently. Darion is a 5-year-old boy with Down syndrome who lives with his mother, Sally, and his father, James. Darion attends the local Head Start program. He loves dinosaurs, grape juice, and his older brother, Jaxon. In the fall, Darion will attend Kindergarten at his neighborhood elementary school. One of the goals that Sally and James have for Darion is to be able to independently drink from a cup when he starts Kindergarten. Currently, Darion uses a spill-proof sippy cup because he often knocks

the cup over when trying to pick it up or set it down. Darion’s parents, therapists, and teacher are collaborating on the best way to teach him how to drink from a cup. Many young children with disabilities struggle with recognizing a cue to perform a specific behavior, identifying what behavior is appropriate in response to a specific cue, and/or knowing how to perform the needed skill or behavior. Not knowing what, when, or how to perform a specific behavior can result in children feeling frustrated, developing antisocial behavior, or becoming highly dependent on others. To promote children’s development, learning, and independence, adults (e.g., parents, teachers, therapists, and other professionals) can provide assistance. An adult who is skilled in providing assistance can influence how quickly and accurately a child learns a new skill or performs it independently. The adult can arrange the environment to create opportunities for children to practice new skills. Adults also can teach a child a new skill by providing help or assistance through prompts, such as telling the child what to do, modeling how to do it, or physically helping a child DOI: 10.1177/1096250613505099 http://yec.sagepub.com © 2013 Division for Early Childhood

Vol. XX, No. X, Month XXXX YOUNG EXCEPTIONAL CHILDREN

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Prompting Strategies / Meadan et al.

complete a task. Prompts are systematic strategies used to increase the likelihood that a child will correctly complete the task or give the appropriate response (Ault & Griffen, 2013; Barton & Wolery, 2010; Snell & Brown, 2011; Westling & Fox, 2009). Adults also need to know how and when to fade their prompting so that children become more independent. The goal of prompting a child is to prevent him from making errors while learning a new skill, and to decrease the amount of time it takes to learn the new skill (Grow et al., 2009; Snell & Brown, 2011; Westling & Fox, 2009). As a child shows improvement in performing the skill, adults can fade the amount of assistance provided until the child reaches his or her level of independence (Snell & Brown, 2011). Several prompting procedures that educators and parents can use to promote children’s learning are described in

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YOUNG EXCEPTIONAL CHILDREN

Vol. XX, No. X, Month XXXX

the literature. In this article, we focus on two prompting procedures, least-to-most and most-to-least. Within the two prompting procedures are five different types of prompts. We will discuss each type of prompt and describe how adults can use these prompts within the least-to-most and most-to-least prompting procedures.

Types of Prompts There are five types of assistance, help, or prompts commonly described in the special education literature (see Tables 1 and 2 for key terms and definitions). Verbal prompts are the most commonly used type of prompt (Grow et al., 2009). There are two types of verbal prompts (a) direct verbal prompts in which the adult tells the child what she needs to do or say (e.g., “Put the puzzle piece here”) and (b) indirect verbal prompts in which the adult gives the child a hint about what he is expected to say or do (e.g., “Remember to look at the shape of the puzzle piece as you try to figure out where it should go”). It is important to remember that although verbal prompts are the prompts educators and parents use most often and may find the most natural, for some children with disabilities, verbal prompts are the least likely prompt type to produce the correct response (Grow et al., 2009). Additional types of prompts can be used to help a child learn new skills. Gestural or nonverbal prompts include pointing, using eye gaze, or gesturing to direct the child’s attention to a task (Snell & Brown, 2011). The adult may also


Table 1 Glossary of Key Terms

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For each child, an adult should select prompts that

•• Errorless Learning: The adult provides prompts to prevent the child from making mistakes while learning a new skill •• Hand-Over-Hand: The adult places her hand over the child’s hand and guides him as he performs the activity •• Hand-Under-Hand: The adult performs the activity while the child’s hand rests on top of the adult’s hand •• Least-to-Most: The adult provides incrementally increasing levels of help, or prompts, to the child •• Most-to-Least: The adult provides progressively less assistance as the child demonstrates proficiency with a task •• Natural Cues: Structures within the environment help the child know what to do next so he can learn to do a skill independently (i.e., other children are lining up for outdoor play; the child realizes that she needs to line up also) •• Prompts: The adult provides systematic strategies to increase the likelihood that a child will correctly complete the task or give the appropriate response •• Time Delay: The child is given a chance to respond while the person providing prompts waits (typically 3-5 s)

are the most helpful to that individual child for that specific task.

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use visual prompts, such as real objects, pictures, drawings, or symbols to provide a child with a cue about what he is expected to do or say (e.g., a teacher might show Darion a picture of himself drinking from a cup, or he might show Darion a photograph of a cup to prompt him that it is snack time). Modeling all or part of a skill is another type of commonly used prompt. In a full model, the adult demonstrates exactly what the child is expected to say or do while in a partial model, the adult demonstrates only part of the expected behavior. Finally, adults can provide help by using physical prompts. Physical prompts include manually guiding the child to perform a specific behavior, giving hand-over-hand guidance (i.e., the adult places her hand over Darion’s hands and guides him as he drinks from a cup), giving hand-underhand guidance (i.e., the adult performs the activity while the child’s hand rests on top of the adult’s hand), or providing partial physical prompts to offer limited

support and guide the child’s movements while he performs the behavior. For each child, an adult should select prompts that are the most helpful to that individual child for that specific task. Some children do not like to be touched and may find physical prompts distracting. Other children may not process verbal information well and may be distracted by a verbal prompt when trying to perform a skill. It is also possible to use more than one type of prompt simultaneously. For example, Samantha’s mother could say, “Put the puzzle piece here,” while pointing to the puzzle, thus giving Samantha a verbal and a gestural prompt at the same time. Darion’s teacher might say, “Pick up the cup” and support Darion’s arm while he is picking up his cup, giving Darion a verbal and physical prompt at the same time. A child may also require more intrusive prompts (i.e., physical support) for some tasks and require less intrusive prompts (i.e., gestural) to independently perform other tasks.


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Table 2 Five Frequently Used Prompts Prompt type Verbal

Description

Example

Direct verbal prompts tell the child what she needs to do or say. Indirect verbal prompts give the child a hint about what he is expected to say or do.

Joy is a 4-year-old girl with Down syndrome. During snack Joy points to the box of crackers. The teacher looks at Joy and says, “What do you want, Joy?” (i.e., indirect verbal prompt). Joy keeps pointing, and the teacher prompts her, “Say ‘More crackers, please’” (i.e., direct verbal prompt). Joy says, “More crackers, please.” The teacher gives Joy more snacks.

Gestural or Nonverbal prompts include gestures that are nonverbal known to the adult and the child, and that cue the child that he is expected to do/say something.

Diana, a 3-year-old girl with a hearing impairment, is running around the classroom while all the children are sitting on the carpet, ready for circle time. The teacher looks at Diana and points (i.e., nonverbal prompt) to Diana’s spot on the carpet. Diana smiles and sits at her spot.

Visual

Visual prompts include real objects, pictures, drawings, or symbols that provide the child with a cue about what he is expected to say or do.

Jordan is a 4-year-old boy with autism. The children are taking turns washing their hands before snack time. The teacher approaches Jordan, who is playing on the carpet. He shows Jordan a picture of himself washing hands (i.e., visual prompt). Jordan goes to the sink to wash his hands.

Model

In a full model, the adult demonstrates exactly what the child is expected to say or do. In a partial model, the adult demonstrates only part of the expected behavior.

Example 1: Ali is a 4-year-old boy with developmental delays. While the other children are putting on their coats before going out to the playground, the teacher models for Ali how to put his coat on by putting her own coat on while explaining what she is doing (i.e., full modeled prompt). After watching the teacher, Ali takes his own coat and puts it on. Example 2: Emily, a 4-year-old girl with a language delay, needs help with her art project. The teacher approaches Emily, looks at her expectantly, and says the initial [h] sound (i.e., partial modeled prompt for “help”). Emily says, “help” and the teacher helps her with her art project.

Physical

Example 1: Jordan is a 4-year-old boy who has a physical disability and uses a Physical prompts include manually guiding the wheelchair. During snack the teacher provides hand-over-hand guidance to child to perform a specific behavior. help Jordan use a spoon to eat his applesauce (i.e., full physical prompt). Full physical prompts—The adult provides handover-hand or hand-under-hand guidance to the Example 2: Mica, a 4-year-old girl with Rett syndrome, needs help drinking her juice. The teacher touches Mica’s elbow to guide her hand while Mica child. picks up her cup and brings it close to her mouth (i.e., partial physical Partial physical prompts—The adult partially prompt). With the teacher’s physical guidance and support, Mica drinks supports and guides the child in performing a her juice. behavior.

For example, Samantha may require model prompts to complete her puzzle but only require gestural prompts (i.e., pointing) to sort blocks into piles.

Prompting Procedures In addition to the different types of prompts just described, there are different types of prompting procedures (Westling & Fox, 2009). Instead of simply providing a single

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prompt when a child makes a mistake or needs assistance, systematically and intentionally providing prompts using prompting procedures prevents the child from making mistakes while learning the new skill (i.e., errorless learning). If a child is allowed to make errors, the child may learn the skill more slowly (Snell & Brown, 2011). Prompting procedures, which include more than one prompt, also increase awareness of the natural cues that help the children know


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In the least-to-most prompting strategy, the adult provides incrementally increasing levels of help, or prompts, to the child

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what to do next so that they can learn to do this skill independently (Grow et al., 2009). Next, we describe two types of prompting procedures, least-to-most assistance and most-to-least assistance. Readers are encouraged to also study information on other types of prompting strategies, such as time delay strategies (see Doyle, Wolery, Gast, & Ault, 1990; Snell & Brown, 2011; Westling & Fox, 2009; Wolery, 2001).

Least-to-Most Assistance The least-to-most prompting procedure is also called the system of least prompts or increasing assistance procedure. In the least-to-most prompting strategy, the adult provides incrementally increasing levels of help, or prompts, to the child (Ault & Griffen, 2013; Neitzel & Wolery, 2009). Prompt types begin with giving the child a chance to respond independently, to the least intrusive prompt for the child, continuing up to the prompt type that provides enough support for the child to complete the task correctly (i.e., controlling prompt). Between each prompt, the child is given a chance to respond while the person providing prompts waits. This wait time is called time delay. “Simply put, the method involves telling a student what to do, showing the student what to do, and finally helping the student to do the task” (Snell & Brown, 2011, p. 165). The following is an illustration of the least-to-most prompting procedure based on one of the opening vignettes. Shalene and Samantha’s therapists meet to discuss the best procedure to use when teaching Samantha to complete puzzles. They decide to use the least-to-most prompting procedure. When Shalene is ready to work on puzzles, she

shows her daughter a picture of a puzzle (i.e., visual prompt), and Samantha goes to the toy shelf and selects her favorite puzzle. Samantha dumps the pieces on the floor but does not seem to know what to do next. Shalene sits down next to Samantha and says, “Pick up a piece” (i.e., verbal prompt) and waits for 3 s (i.e., time delay), counting silently in her head. Samantha just smiles at her mother, so Shalene tries the next prompt in Samantha’s prompt hierarchy (i.e., gestural prompt). After getting Samantha’s attention, Shalene points to a puzzle piece and says “Pick up a piece” (i.e., gestural and verbal prompt). Before Shalene could count to three in her head, Samantha reaches for the puzzle board and Shalene quickly interrupts her daughter’s movement by gently guiding Samantha’s arm toward the puzzle piece by pressing on her elbow (i.e., partial physical prompt). While Samantha lets her mom move her arm toward the pieces, she does not attempt to pick up a puzzle piece. After waiting for three more seconds, Shalene takes Samantha’s hand and helps her pick up the puzzle piece (i.e., full physical assistance). “Good job picking up a puzzle piece, Sammy!” Shalene says (i.e., reinforcement). Samantha grins at her mother as Shalene helps her put the piece into the correct spot. When the puzzle piece is in place, Shalene claps and then waits for 3 s to see if Samantha will pick up the next puzzle piece on her own. In this example, Shalene provided increasing levels of help to Samantha while giving her a chance to put the puzzle piece in after each prompt. When Samantha did not complete the step independently, Shalene supported her with the next level in the prompt hierarchy. When Samantha successfully put the puzzle


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piece in, Shalene provided Samantha with descriptive feedback or reinforcement.

Most-to-Least Assistance The most-to-least prompting procedure is similar to the least-tomost procedure, but the prompts proceed in the opposite direction. In the most-to-least strategy, the adult provides progressively less assistance as the child demonstrates proficiency. The first level includes the most help the child needs to complete the task correctly, while the last level includes no prompt (i.e., independent level). Darion’s IEP team agreed on using a most-to-least prompting schedule to help Darion learn to drink from a cup without a lid. Sally, James, and Jaxon take turns helping Darion practice during each snack and meal at home, and the EC teacher practices with Darion during snack at school.

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During the first 2 weeks of drinking from a lidless cup, Darion’s family provides him with full physical assistance. They make sure Darion’s cup is just out of his reach, and, whenever Darion reaches toward his cup, a family member moves behind Darion and says, “Pick up your cup with both hands,” while they hold Darion’s hands and help him bring the cup to his lips and take a sip (i.e., verbal and full physical assistance). When Darion is ready to set the cup down, the adult says, “Put it down carefully,” and helps Darion set the cup down (i.e., verbal and full physical prompt). After 2 weeks, Darion’s family begins to hold his wrists while he drinks from the lidless cup, rather than holding his hands (i.e., partial physical assistance). They continue to remind him to “pick up your cup with both hands” and to “put it down carefully.” After 2 weeks of practice with partial physical assistance, Darion’s family is ready to fade their prompts again. When Darion reaches for his cup, James says, “Pick up your cup with both hands” (i.e., verbal prompt) while also taking a sip from his own cup, using both of his hands (i.e., a model). Darion watches his dad and then picks his cup up and drinks without spilling. “Put it down carefully,” James says as he sets his own cup down to show Darion how (i.e., a model). When Darion attempts to take another sip, James provides the same verbal and model prompts, but the cup tips over when Darion sets it down. When this happens a third time, Sally and James go back to providing partial physical assistance when Darion sets his cup down. For a week, Darion picks up his cup and takes a sip


Table 3 Checklist for Preparing to Implement Prompting Procedures ü Identify the target skill/behavior •• Decide which skill/behavior you want the child to learn. ü Select cues or task directions •• Choose the stimulus that will cue the child to perform the target behavior. ü Identify activities and times for teaching •• Decide when and where the prompting procedure will be used. ü Identify the people who will use the prompting procedure •• Decide if a teacher, paraprofessionals, parents, peers, or a combination of significant others will implement the prompting procedure. ü Identify the types of prompts to be used •• Select the types(s) of prompt (e.g., gestural/nonverbal, visual, verbal, modeled, physical, or a combination of more than one type of prompt) to be used. ü Identify the type of prompting procedure to be used •• Select least-to-most, most-to-least, or another prompting procedure (e.g., time delay) to be used. ü Make the necessary decisions for using the selected prompting procedure •• Least-to-most—Determine the wait time or time delay to be given between each prompt. •• Most-to-least—Determine how long a prompt will be used before fading to the next prompt. Determine how many mistakes will indicate a need to return to the previous prompt type. ü Identify the type of reinforcement to be used •• Select a reinforcer that will work and is appropriate for the child, target skill, and setting.

with only a model and verbal prompt; Sally and James hold

Darion’s wrists while he sets the cup down (i.e., partial physical assistance). After the extra week of practice with partial physical assistance, Sally and James try fading to model prompts again. This time, Darion only spills once during the 1st day of model prompts. After 2 weeks of models paired with verbal reminders and only two spills, James and Sally stop modeling and only provide verbal reminders whenever Darion takes a drink (i.e., verbal prompt). Two weeks later, Darion drinks from his lidless cup without any verbal prompts or spills. Everyone is excited that Darion will not need a special cup in Kindergarten, and Darion shows how proud he is of himself with a big grin.


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Educators and parents can promote children’s learning and independence by using different types of prompts and prompting procedures.

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Before they began teaching Darion to drink from his cup, the team decided to use each prompt for 2 weeks. Darion’s family used each prompt for 2 weeks and then moved to the next less intrusive prompt. When that prompt was not enough help for Darion on three tries, his family scaled back to use the previous prompt for an extra week. Like Samantha and Darion’s families, educators and parents can promote children’s learning and independence by using different types of prompts and prompting procedures. The decision about the type of prompts and prompting procedure to use should be based on

the individual child and the target behavior (e.g., Bailey & Wolery, 1992a; Bailey & Wolery 1992a, 1992b). It is possible that for any given child, different prompting procedures will be appropriate for different target behaviors (Libby, Weiss, Bancroft, & Ahearn, 2008). Careful and critical observation by adults will help them determine what prompting procedure to use. Ongoing assessment will enable adults to evaluate if the procedure is working or if changes should be made. The checklist provided in Table 3 can guide teams as they prepare to implement prompting procedures to systematically and intentionally support a child’s development.

Authors’ Note You may reach Hedda Meadan by e-mail at [email protected].

References Ault, M. J., & Griffen, A. K. (2013). Teaching with system of least prompts: An easy method for monitoring progress. Teaching Exceptional Children, 45(3), 46-53. Bailey, D. B., & Wolery, M. (1992a). Designing and arranging environments for infants and preschoolers with disabilities. In A. Castel & S. G. Langner (Eds.), Teaching infants and preschoolers with disabilities (2nd ed., pp. 161196). Englewood Cliffs, NJ: Prentice Hall. Bailey, D. B., & Wolery, M. (1992b). Strategies for intervention: Teaching procedures and options. In A. Castel & S. G. Langner (Eds.), Teaching infants and preschoolers with disabilities (2nd ed., pp. 197-227). Englewood Cliffs, NJ: Prentice Hall. Barton, E. E., & Wolery, M. (2010). Training teachers to promote pretend play in young children with disabilities. Exceptional Children, 77, 85-106. Doyle, P. M., Wolery, M., Gast, D. L., & Ault, M. J. (1990). Comparison of constant time delay and the system of least prompts in teaching preschoolers with developmental delays. Research in Developmental Disabilities, 11, 1-22. doi:10.1016/0891-4222(90)90002-P Grow, L. L., Carr, J. E., Gunby, K. V., Charania, S. M., Gonsalves, L., Ktaech, I. A., & Kisamore, A. N. (2009). Deviations from prescribed prompting procedures: Implications for treatment integrity. Journal of Behavioral Education, 18, 142-156. doi:10.1007/s10864-009-9085-6 Libby, M. E., Weiss, J. S., Bancroft, S., & Ahearn, W. H. (2008). A comparison of most-to-least and least-to-most prompting on the acquisition of solitary play skills. Behavioral Analysis in Practice, 1, 37-43.



Neitzel, J., & Wolery, M. (2009). Steps for implementation: Least-to-most prompting (Module). Retrieved from http://autismpdc.fpg.unc.edu/sites/ autismpdc.fpg.unc.edu/files/Prompting_Steps-Least.pdf Snell, M. E., & Brown, F. (2011). Selecting teaching strategies and arranging educational environments. In M. Brown & F. Brown (Eds.), Instruction of students with severe disabilities (pp. 122-185). Upper Saddle River, NJ: Pearson. Westling, D. L., & Fox, L. (2009). Teaching students with severe disabilities (4th ed.). Upper Saddle River, NJ: Pearson. Wolery, M. (2001). Embedding constant time delay procedures in classroom activities. In M. Ostrosky & S. Sandall (Eds.), Teaching strategies: What to do to support young children’s development (Young Exceptional Children Monograph Series No. 3, pp. 81-90). Longmont, CO: Sopris West.


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